Motivational Enhancement Therapy Increases Alcohol Abstinence in Patients with HCV and Alcohol Use Disorders

To determine whether motivational enhancement therapy (MET) can reduce alcohol use among patients with hepatitis C (HCV) and alcohol use disorders, this clinical trial randomized 139 of these patients to MET (n = 70), or to general health education sessions (n = 69) for 3 months, with follow-up 3 months later. Study clinicians were mainly psychologists who delivered the MET or health education in 4 30–45 minute sessions. The follow-up rate exceeded 84%; intent to treat analysis was performed.

• MET increased the percentage of days abstinent from baseline (35%) to follow-up (73%), which was significantly greater than the change (35% to 59%) in the control group.
• Drinks per week dropped in both groups and did not differ.
• Secondary outcomes—including heavy drinking days, 30-day abstinence, carbohydrate-deficient transferrin (CDT), and antiviral treatment initiation—did not differ across the groups.

Comments:

MET appeared to increase the proportion of self-reported abstinent days, although objective measures like CDT did not differ, making it possible that reporting effects (e.g., social desirability in the MET group) may explain the findings. It is also unclear whether a 13 percentage-point increase in abstinent days would have a meaningful effect on the natural history of HCV. Alcohol use was a relative contraindication to pegylated interferon and ribavirin treatment for HCV. It remains to be seen whether it will remain a barrier to HCV treatment in the new era of highly efficacious and well-tolerated direct antiviral agents.

Peter D. Friedmann, MD, MPH

Reference:

Dieperink E, Fuller B, Isenhart C, et al. Efficacy of motivational enhancement therapy on alcohol use disorders in patients with chronic hepatitis C: a randomized controlled trial. Addiction. 2014;109(11):1869–1877.